This too shall pass: A study of ingested sharp foreign bodies.

BACKGROUND: Gastrointestinal foreign body (GFB) ingestion is a common problem and often results in surgical consultation. Current literature is limited to case reports and fails to provide data regarding the management of sharp GFB ingestion. We hypothesized that patients who ingest sharp objects rarely have perforation or obstruction requiring surgical intervention. METHODS: Patients presenting with GFBs from 1/05-12/15 at a level 1 trauma center with an acute care surgery program were retrospectively reviewed. Exclusion criteria were leaving without being seen, non-ingested GFB, unknown or blunt GFB, or if the GFB was not found on imaging. Data collected included patient demographics, length of stay, imaging and interventions that were performed. RESULTS: During the study period, there were 1164 patients with 1245 hospital visits for GFBs; 995 visits were excluded, resulting in 169 sharp GFB ingestion patients with 192 visits included in our study. The average age was 31. 65% were male and 41% were incarcerated. The average length of stay was 3 days, which was longer in patients with psychiatric holds and consultations. Of the 169 patients, 116 (69%) had no intervention and did not return for complications. 55 endoscopies were performed with GFB removal in 30 cases. Seven patients (4%) underwent surgery, 5 of which had peritonitis. When evaluating the total study cohort, 134 (79%) of the patients had no procedure or a negative procedure. Patients requiring surgery had significantly larger objects (6+/-3cm) than those who had endoscopy (3+/-2cm) or no procedure (2+/-1cm). CONCLUSIONS: Surgical intervention occurred in only 7 (4%) patients with sharp GFB ingestions, and 79% of patients required no intervention. Barring an acute abdomen or esophageal sharp GFBs, patients can be discharged with return precautions, admitted for necessary psychiatric care, or returned to custody for patients seeking secondary gain. Upper GI larger GFBs should be removed endoscopically when possible. LEVEL OF EVIDENCE: Level III Therapeutic/Care Management (C) 2016 Lippincott Williams & Wilkins, Inc.

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